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When it comes to solving the opioid addiction problem in the U.S., is decreasing the demand for the drugs or stopping the supply more important? Differing opinions were on display at a House Oversight and Accountability Committee hearing Thursday on funding the White House Office of National Drug Control Policy (ONDCP).

"We need to understand from the ONDCP what is working, what isn't working, and what can be improved by legislation, to prevent illicit drugs from coming into our country, entering our communities, and poisoning our families, friends, and neighbors," said Committee Chair Rep. James Comer (R-Ky.). "We need to know what ONDCP is doing to disrupt the criminal organizations that traffic in human misery and smuggle enormous quantities of drugs across our Southern border."

But Rep. Jamie Raskin (D-Md.), the committee's ranking member, had a different focus. "It does no service to our communities and our families harmed by addiction to completely blame opioid overdoses on a crisis -- whether real or fake -- at the Southern border," he said. "We're talking about more than 40 million people in America who have substance use disorders, with many of them facing serious underlying mental health conditions ... We must reauthorize ONDCP to ensure that America's young people have access to treatment, both for substance use disorders and other mental illnesses, so they do not end up overdosing or going to prison for committing drug-related crimes."

ONDCP Director Rahul Gupta, MD, MPH, tried to walk a fine line for his office, whose funding was last authorized in 2018. Its current annual budget is $41 billion.

When it comes to people with substance use disorders, "some say we need to lock up everyone involved," Gupta said. "Just lock them up and throw away the key. Others say we should focus on treatment and ignore drug traffickers. With an American dying every 5 minutes around the clock, we can't just focus on supply or just on demand. We've got to do both, because we cannot treat dead people."

Illicit drugs are easily available via a smartphone, "and the emerging threat of fentanyl mixed with xylazine -- commonly known as Tranq -- has made matters worse," he continued. "Tranq dope is making fentanyl look like a walk in the park."

"The global supply chain for synthetic drugs is more robust than ever, with precursors predominantly coming from China, which refuses to cooperate on counter-narcotics [efforts]," Gupta noted. "So we're bringing world leaders together to address the global supply of precursor chemicals for synthetic drugs, with or without China."

Gupta claimed that his office has been making progress. "In 2022, overdose deaths flattened after a sharp rise for several years ... [Notorious Mexican drug kingpin] El Chapo's son is behind bars, and naloxone is over the counter," he said. "And treatment for addiction is more accessible than it's ever been. Still, we cannot stop. We must keep pushing forward."

But Republicans were not satisfied. "As our nation faces an unprecedented crisis of incoming deadly drugs across our Southern border, we've got to call for a great deal of coordination between the Executive Branch and your particular department, which we have to determine if we intend to support reauthorization or not, and I'm not there yet," said Rep. Clay Higgins (R-La.). "As a law enforcement professional myself, I have questions about the direction that you're leading your department."

Higgins asked Gupta how often he met with officials from Customs and Border Protection (CBP) and the Immigration and Customs Enforcement's Homeland Security Investigations (HSI) division. "I just had a phone call this week with the acting commissioner Troy Miller of CBP, and I intend to see him again next week," Gupta said. As for HSI, "I have 'detailees' in my office" daily from CBP, HSI, and other federal law enforcement agencies, he added.

Rep. Glenn Grothman (R-Wisc.) disputed Gupta's assertion that the vast majority of illegal drugs that come through the country's Southern border come through legitimate points of entry rather than illegal border crossings. Instead, Grothman said, most of the drugs are carried over -- successfully -- by "got-aways," the immigrants who evade the border guards.

"If you talk to the Border Patrol, what they will tell you is ... we have well over 30,000 got-aways who come across the border when there's diversions made by the Mexican drug cartels," he said. "We don't catch them with drugs because we don't catch them at all. The guys on the ground, the guys with the Border Patrol, believe that most of these drugs are coming through got-aways but they don't show up in the statistics because they got away, and the reason they're getting away, is because there is a lack of Border Patrol agents."

Rep. Maxwell Frost (D-Fla.) asked Gupta about getting substance use disorder treatment for people who are incarcerated. "Approximately 85% of the prison population has an active substance use disorder or were incarcerated in connection with drugs or drug use," Frost said. "Forced [substance use] withdrawal in prison can be deadly. How has your office supported the expansion of substance use treatment for incarcerated folks?"

Gupta agreed this was a problem; he noted that when prisoners with substance use issues are released, "they're up to 120 times more likely to die from overdose or be re-incarcerated." If they get treatment in prison, however, "they are not only 85% less likely to die, but they actually go back and assimilate to the community and be contributing members to the community," he added. "So we are both working within the Federal Bureau of Prisons to expand treatment, so anyone who wants treatment is offered treatment."

In addition, "we're also providing to states -- 15 states have already applied for the waivers -- to get treatment available for 90 days before [a prisoner's] release," Gupta said. Two states, California and Washington, have had their waivers approved.

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